Autologous bone graft is considered as the gold standard for all indications for bone grafting procedures but the limited availability and complications in donor site resulted in seeking other options like allografts ...Autologous bone graft is considered as the gold standard for all indications for bone grafting procedures but the limited availability and complications in donor site resulted in seeking other options like allografts andbone graft substitutes. Demineralized bone matrix(DBM) is an allograft product with no quantity limitation. It is an osteoconductive material with osteoinductive capabilities, which vary among different products, depending on donor characteristics and differences in processing of the bone. The purpose of the present review is to provide a critical review of the existing literature concerning the use of DBM products in various procedures in the extremities. Clinical studies describing the use of DBM alone or in combination with other grafting material are available for only a few commercial products. The Level of Evidence of these studies and the resulting Grades of Recommendation are very low. In conclusion, further clinical studies of higher quality are required in order to improve the Recommendation Grades for or against the use of DBM products in bone grafting procedures.展开更多
目的探讨异体脱钙骨基质(dem inera lized bone m atrix,DBM)复合重组人骨形态发生蛋白2(reconstruc-tion hum n bone m orpho logy prote in-2,rhBM P-2)修复节段性骨缺损的能力。方法48只新西兰大白兔采用桡骨15mm节段性骨缺损模型,...目的探讨异体脱钙骨基质(dem inera lized bone m atrix,DBM)复合重组人骨形态发生蛋白2(reconstruc-tion hum n bone m orpho logy prote in-2,rhBM P-2)修复节段性骨缺损的能力。方法48只新西兰大白兔采用桡骨15mm节段性骨缺损模型,随机分为3组,A组植入异体DBM与rhBM P-2复合材料,B组植入异体DBM,C组为空白对照组。术后4周、8周、12周、16周,进行放射学和组织学检查。结果A组:术后4周宿主结缔组织长入植骨材料内的骨小梁间,并有岛状新生软骨、骨组织形成;术后8周,新生软骨及骨形成并融合成片;术后12周,新骨改建成熟,但仍能见到植骨材料;术后16周,管状骨结构形成,髓腔再通。B组:术后4周,植骨材料周围有软骨形成;术后8周,大量软骨形成;术后12周,大片状骨形成;术后16周,有髓腔形成。C组:各时间点仅见有纤维结缔组织,只在两端有新骨形成。X片示A组成骨量大,新骨改建、成熟迅速,术后16周全部达骨性愈合。B组成骨量少,仅2例达骨性愈合。C组未见骨性愈合。结论异体DBM复合rhBM P-2材料通过骨诱导和骨传导两种方式修复骨缺损,是一种较理想、具有高效成骨活性的植骨材料。展开更多
Adolescent idiopathic scoliosis （AIS） is one of the most prevalent diseases among teenagers, with an incidence rate of 1-3% worldwide, and at least 0.02% of patients require surgical treatment. The ＂gold standard＂...Adolescent idiopathic scoliosis （AIS） is one of the most prevalent diseases among teenagers, with an incidence rate of 1-3% worldwide, and at least 0.02% of patients require surgical treatment. The ＂gold standard＂ procedure is instrumentation and fusion of 10 or more vertebrae with forceful correction of the deformity.Although autogenous bone grafts are the ＂gold standard＂ for spine fusion, significant progress has been made in discovering bone graft alternatives, including freeze-dried allograft, demineralized bone matrix （DBM）, triosite ceramics, and bone marrow aspirate （BMA）, which have been used as substitutes for iliac crest in AIS surgery.展开更多
脊柱融合是脊柱外科中最常用的手术方式之一,在术中选择合适的植骨材料具有十分重要的意义。一种良好的骨移植材料需同时具备骨传导性、骨诱导性和成骨性三大特性。目前,临床上应用最广泛的骨移植材料为同种异体骨,包括新鲜冰冻骨、冻...脊柱融合是脊柱外科中最常用的手术方式之一,在术中选择合适的植骨材料具有十分重要的意义。一种良好的骨移植材料需同时具备骨传导性、骨诱导性和成骨性三大特性。目前,临床上应用最广泛的骨移植材料为同种异体骨,包括新鲜冰冻骨、冻干骨和脱钙骨基质(demineralized bone matrix,DBM)三类,新鲜冰冻骨具有最高的机械稳定性,但存在免疫反应和疾病传播的危险性;冻干骨在其制备过程中,水分的丢失和辐照的电离破坏了其力学性能;DBM是一种由胶原蛋白(主要为Ⅰ型、Ⅳ型)、非胶原蛋白、生长因子、少量磷酸钙和细胞碎片等组成的天然骨移植材料,具有良好的骨诱导性及一定的骨传导性。目前,随着骨移植替代材料研究深入,DBM显示出了相当大的优势,同时在脊柱融合中发挥了重要作用。展开更多
文摘Autologous bone graft is considered as the gold standard for all indications for bone grafting procedures but the limited availability and complications in donor site resulted in seeking other options like allografts andbone graft substitutes. Demineralized bone matrix(DBM) is an allograft product with no quantity limitation. It is an osteoconductive material with osteoinductive capabilities, which vary among different products, depending on donor characteristics and differences in processing of the bone. The purpose of the present review is to provide a critical review of the existing literature concerning the use of DBM products in various procedures in the extremities. Clinical studies describing the use of DBM alone or in combination with other grafting material are available for only a few commercial products. The Level of Evidence of these studies and the resulting Grades of Recommendation are very low. In conclusion, further clinical studies of higher quality are required in order to improve the Recommendation Grades for or against the use of DBM products in bone grafting procedures.
文摘目的探讨异体脱钙骨基质(dem inera lized bone m atrix,DBM)复合重组人骨形态发生蛋白2(reconstruc-tion hum n bone m orpho logy prote in-2,rhBM P-2)修复节段性骨缺损的能力。方法48只新西兰大白兔采用桡骨15mm节段性骨缺损模型,随机分为3组,A组植入异体DBM与rhBM P-2复合材料,B组植入异体DBM,C组为空白对照组。术后4周、8周、12周、16周,进行放射学和组织学检查。结果A组:术后4周宿主结缔组织长入植骨材料内的骨小梁间,并有岛状新生软骨、骨组织形成;术后8周,新生软骨及骨形成并融合成片;术后12周,新骨改建成熟,但仍能见到植骨材料;术后16周,管状骨结构形成,髓腔再通。B组:术后4周,植骨材料周围有软骨形成;术后8周,大量软骨形成;术后12周,大片状骨形成;术后16周,有髓腔形成。C组:各时间点仅见有纤维结缔组织,只在两端有新骨形成。X片示A组成骨量大,新骨改建、成熟迅速,术后16周全部达骨性愈合。B组成骨量少,仅2例达骨性愈合。C组未见骨性愈合。结论异体DBM复合rhBM P-2材料通过骨诱导和骨传导两种方式修复骨缺损,是一种较理想、具有高效成骨活性的植骨材料。
基金grants from the National Natural Science Foundation of China，Shanghai Natural Science Foundation，Youth Project of Shanghai Municipal Health and Family Planning Commission
文摘Adolescent idiopathic scoliosis （AIS） is one of the most prevalent diseases among teenagers, with an incidence rate of 1-3% worldwide, and at least 0.02% of patients require surgical treatment. The ＂gold standard＂ procedure is instrumentation and fusion of 10 or more vertebrae with forceful correction of the deformity.Although autogenous bone grafts are the ＂gold standard＂ for spine fusion, significant progress has been made in discovering bone graft alternatives, including freeze-dried allograft, demineralized bone matrix （DBM）, triosite ceramics, and bone marrow aspirate （BMA）, which have been used as substitutes for iliac crest in AIS surgery.
文摘脊柱融合是脊柱外科中最常用的手术方式之一,在术中选择合适的植骨材料具有十分重要的意义。一种良好的骨移植材料需同时具备骨传导性、骨诱导性和成骨性三大特性。目前,临床上应用最广泛的骨移植材料为同种异体骨,包括新鲜冰冻骨、冻干骨和脱钙骨基质(demineralized bone matrix,DBM)三类,新鲜冰冻骨具有最高的机械稳定性,但存在免疫反应和疾病传播的危险性;冻干骨在其制备过程中,水分的丢失和辐照的电离破坏了其力学性能;DBM是一种由胶原蛋白(主要为Ⅰ型、Ⅳ型)、非胶原蛋白、生长因子、少量磷酸钙和细胞碎片等组成的天然骨移植材料,具有良好的骨诱导性及一定的骨传导性。目前,随着骨移植替代材料研究深入,DBM显示出了相当大的优势,同时在脊柱融合中发挥了重要作用。
